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Re: No Posts!From: Andrew Folley (agfolley@hotmail.com)Thu Nov 29 13:37:04 2007
I still have not heard a good argument for doing GBS cultures on women planning repeat c-section. If they show up for the scheduled c-section they did not need the culture. If they come in and decide to be vbac they are either treated as a full term ob with GBS undetermined in which case they are treated based on risk factors, ie >18 hrs ROM or temp >38 C Having said this however, since the ACOG opinion is to get GBS cultures on ALL women other than for those with GBS bacteruria in present pregnancy or hx of GBS disease in prior baby, I guess I will need to start doing cultures on the repeat c-sections at 35-37 weeks. Date: Thu, 29 Nov 2007 14:15:43 -0600From: dkrell@msn.comTo: ob-gyn-l@dns.obgyn.netSubject: RE: No Posts! This patient was screened. GBS +. Penicillin treated in labor w/ at least 2 doses. She did not seek any legal remedy, but had she not been screened, their would have been clear legal exposure. I only brought up this case as an example of how unpredictable this organism is...even when we follow guidelines. Douglas Krell MD Date: Wed, 28 Nov 2007 19:04:41 -0600From: rd.braun@gmail.comTo: ob-gyn-l@dns.obgyn.netSubject: Re: No Posts!How would your screening have helped? That baby needed treatment 48 hours before it was born for it to have done much to help.Dan On Nov 28, 2007 5:13 PM, Douglas Krell < dkrell@msn.com> wrote: Dan, I had a case of twins where twin A was born vaginally unresuscitatable with fulminate GBBS pnuemonia, twin B separate sac breech extraction, was perfectly fine. The mother had been GBBS +. The organism went right through the membranes and killed baby A and a few hours of PCN didn't help. Since then I have screened everyone...I'm just catching a little crap for it.I'll probaBLY CONTINUE to screen if other people do as well. Doug Date: Wed, 28 Nov 2007 15:23:57 -0600From: rd.braun@gmail.com To: ob-gyn-l@dns.obgyn.net Subject: Re: RE: No Posts! I am aware of one suit brought on this ground. The baby died of GBBS sepsis within 20 hours of delivery. Patient had been in Hospital for less than 2 hours prior to section. Defence was victorius, case never went to court. Dan On Nov 28, 2007 4:08 PM, Meenan, Anna <annam@uic.edu> wrote: We do it, mainly because it would be good to know if the pt. comes inand has a precipitous, unplanned VBAC (in order to decide how todeal with the baby in the nursery). Likewise if she ruptures at home and doesn't realize it (have had this happen to me at least twice in my career) and comes in more than 18 hours later.Otherwise, probably not necessary.Anna Meenan, MD
>I guess we have been doing it routinely regardless... >and now that you mention it..it seems unecessary and foolish...yet>another unecessary test.>fr 07
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